Risk of postoperative urinary retention with early removal of the urinary catheter after surgery with epidural analgesia: A systematic review and meta-analysis

Abstract

Introduction: It is unclear whether the early removal of urinary catheters during epidural analgesia increases postoperative urinary retention. This systematic review and meta-analysis aimed to evaluate the risk of postoperative urinary retention by comparing early removal with late removal of urinary catheters after surgery with epidural analgesia. Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, World Health Organization International Clinical Trials Registry Platform, and Clinical Trials.gov for randomized controlled trials involving early versus late removal of urinary catheters after surgery with epidural analgesia. Primary outcomes were postoperative urinary retention and urinary tract infection, and we conducted a meta-analysis using a random-effects model to calculate the pooled estimates of risk differences. The Cochrane risk of bias tool and Grading of Recommendations, Assessment, Development, and Evaluation approach were used to assess the quality of individual studies and the overall body of evidence, respectively. Results: Four studies involving 584 patients were included. The pooled risk difference of early versus late removal was 0.05 (95% confidence interval,-0.01–0.10; I2 = 59%) for postoperative urinary retention and-0.03 (95% confidence interval,-0.12–0.05; I2 = 89%) for urinary tract infection. We did not conduct a meta-analysis regarding length of stay. Conclusions: Early urinary catheter removal may be associated with a 5% increased risk of postoperative urinary retention. We could not conclude whether this increased risk of postoperative urinary retention is clinically acceptable or not.